Comparative Performance of Alb-dNLR, Prognostic Nutritional Index, and High-Sensitivity Troponin I for Predicting In-Hospital Mortality in Coronary Artery Disease
Keywords:
Coronary artery disease, Alb-dNLR, Prognostic nutritional index, Troponin I, In-hospital mortality, InflammationAbstract
Background and aim: In hospitalized patients with coronary artery disease (CAD), short-term outcome is influenced not only by myocardial injury but also by inflammatory activation, nutritional status, and immune reserve. This study compared the ability of the albumin-derived neutrophil-to-lymphocyte ratio score (Alb-dNLR), the Prognostic Nutritional Index (PNI), and high-sensitivity Troponin I (Hs-Troponin I) to predict in-hospital mortality among patients with CAD.
Methods: This retrospective cohort study included adult patients admitted with CAD to Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia, between January 2023 and December 2024. Admission laboratory results were used to calculate PNI and Alb-dNLR. The outcome of interest was all-cause mortality during hospitalization. Between-group comparisons, receiver operating characteristic (ROC) analysis, and binary logistic regression were performed to assess the prognostic value of each marker.
Results: Among 243 patients, 49 (20.2%) died during hospitalization. Leukocyte count, neutrophil percentage, neutrophil-to-lymphocyte ratio, and Alb-dNLR score were higher in non-survivors, whereas lymphocyte count, total lymphocyte count, albumin, and PNI were lower. Hs-Troponin I did not differ significantly between outcome groups. Alb-dNLR showed the best discrimination for mortality (AUC 0.745; 95% CI 0.679-0.810), followed by PNI (AUC 0.699; 95% CI 0.625-0.773) and Hs-Troponin I (AUC 0.552; 95% CI 0.468-0.636). In the final logistic regression model, Alb-dNLR remained an independent predictor of mortality (OR 2.774; 95% CI 1.568-4.906; P < 0.001).
Conclusions: Alb-dNLR outperformed PNI and Hs-Troponin I for predicting in-hospital mortality in hospitalized patients with CAD. Integrating inflammatory and nutritional markers may improve early risk stratification in CAD.
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